The top 5 challenges of setting up critical care within a maternity unit.

Ka Yee Tseung. Senior Anaesthetic Sister. Labour Ward, Chelsea and Westminster Hospital, London

The Chelsea and Westminster Hospital maternity unit is a tertiary referral center for high-risk obstetric care. During 1998 there were 3688 deliveries. The epidural rate for labour was 60.9% (62.6% for primiparous women and 29.5% for multiparous) The overall caesarean section rate was 21.8% (14.1% emergency and 7.7% elective)

Prior to the start of creating a designated high dependency/recovery unit (HDU) in 2000, the following concerns had been expressed through the monthly Integrated Maternity Services Meeting (incorporating obstetric, midwifery and anaesthetic staff). Firstly, the provision of critical care within the labour ward for high risk obstetric patients with medical conditions. Secondly, regarding the number of "near - miss" critical incidents relating to the management and standard of care for post-operative recovery patients. The most common occurrence was the late diagnosis of occult postpartum haemorrhage after caesarean section. Particular areas of concern were identified including the absence of a designated area for high-risk patients and those immediately after operative procedures. This resulted in patients being scattered throughout the postnatal ward. Not only did this make it difficult to provide close observation but also there was a lack of specific observations and haemodynamic-monitoring protocols by appropriately trained staff.

This presentation highlights 5 key challenges identified during the process of setting up this unit; different perceptions in changing culture, demands on resources, formal training structure within training, establishing guidelines/protocols in developing practices and a collaborative approach to building team relationships.

In the face of these challenges and the development of this service, in some areas we have not progressed as quickly as anticipated. However, we are confident that further targets will be achieved in the near future as we continue to work towards developing the unit.